Highlights in the minimally invasive treatment of SUI in women.

Objective: Treatment of stress urinary incontinence consists of a wide range of options, from conservative therapies like lifestyle changes, medication, pelvic floor muscles exercises, electro-stimulation, to minimally invasive procedures- injection of collagen, suburethral slings TVT / TOT and last but not least, invasive surgical treatment reserved for recurrent and complex cases. Among the latest minimally invasive procedures reported in literature, the injection of intra-and perisphincterian of autologous stem cell (mioblasts and /or mature fibroblasts grown and multiplied in the laboratory from biopsy samples taken from the pectoralis muscles). Material and method: On October 18, 2010, in ‘Fundeni’ Clinical Institute of Uronephrology and Renal Transplantation was performed the first stem cell implantation procedure in the urethral sphincter, in Romania. Results: Assessment at 6 weeks, the quality of life questionnaires, micturition diary and clinical examination revealed a stunning decrease of urine loss from 6 pads / day at one per day, which significantly improved the patient's quality of life. Conclusions: Stem–cell–mioblasts therapy may represent in the future an every–day intervention in the urologist's armamentarium. The effectiveness of this treatment can change the course of therapy and last but not least, the accessibility to urological evaluation of patients with stress urinary incontinence. Clinical and urodynamic evaluations will continue and will be future scientific topics


Introduction
Stress urinary incontinence is a symptom/sign/condition that is defined by involuntary loss of urine that occurs during physical activity, with the effort of coughing, sneezing, laughing, prolonged standing, sexual activity, etc. [1]. Although not life threatening, it is certainly a public health problem, affecting the quality of life, mainly of the female population. The prevalence of this disorder reaches alarming rates, about 20% of total female population being affected, percentages increasing to 35% for those aged over 60 years [2,3].
Urinary continence and the act of micturition depend on the normal functioning of the lower urinary tract and of the nervous system. Two muscular structures are mainly involved in controlling the act of micturition: -the urethral sphincter, which must be fully functional in order to facilitate continence and micturition; -the detrusor, the bladder muscle layer, which should gradually relax to allow the filling of the bladder and to contract efficiently in order to eliminate the urine.
Whenever the pelvic floor structures are impaired, the base of the bladder and the urethra would weaken, with the appearance of urinary incontinence due to the increasing of the abdominal pressure during efforts (coughing, laughing, sneezing, exercise). In addition, it has been described an entity in which the components of the pelvic floor are not affected, still the urine loss persists, the mechanism being described as intrinsic sphincter deficiency [1].
The treatment of SUI consists in a wide range of options, from conservative therapies including lifestyle changes, medication, pelvic floor muscles exercises, electrostimulation to minimally invasive -injection of

implantation
It in Sonoject-wh the biopsy is a syringe con a 20MHz circ external ureth device is fix surgical tabl together with which the "So The general anes perineal area the procedur   Posterior compartment prolapse and anal incontinence are evaluated by the general surgeon or proctologist, uterine and vaginal prolapse, dyspareunia by the gynecologist and cystocele and low urinary tract symptoms by the urologist. Urinary incontinence and pelvic floor prolapse are two pathological entities that occur as a result of structural damage to several components of the urogenital diaphragm. Thus, according to the first symptoms that appear, the first presentation to the doctor, the outcome of treatment, follow-up are carried out by the specialist who treated only a symptom for which the patient initially presented, though as we mentioned above, the pathogenesis is multifactorial and the symptoms appear after the breakdown of the structures with a high grade of fragility. For this reason, many patients receive an incomplete treatment, which often worsens the clinical background or trigger other symptoms caused by other structures which, at the time of presentation, were compensated. Suburethral slings, inserted transobturatory, were introduced in Europe several years ago. This procedure was carried out by urogynecologist despite the absence of long-term data regarding efficiency and the rate of healing. The same thing happened with TVT's when they were introduced and, although the medium and long term data were lacking, they were adopted and became today's gold-standard treatment for SUI in women. Abdel-Fattah has recently published a series of reports [14,15] that assessed physicians' preferences for minimally invasive treatment of stress urinary incontinence. The results were encouraging and emphasized that one third of respondents considered that TVT-O was a procedure up-to-date and must be applied immediately, while others expect the medium and long term statistics.
Treatment is tailored to the patient's suffering and not just treats the loss of urine. In other words, a successful therapy includes the main objective parameters (dry/wet) and the subjective quality of life which is assessed by questionnaires [16]. However, understanding the "results" and the statistical methods used in their quantification are not homogeneous and sufficiently clear in order to remove any controversy. Before we compare and decide which is the most effective procedure, we should reach a consensus on the definition of "results", how they should be measured, follow-up intervals, etc. Until these issues are clarified, the urologist will continue to choose one of the many existing procedure and will remain autonomous in his selection. Thus, the need for new therapeutic methods, that can restore as close as possible the integrity of the pelvic structures, is urgently required.

Conclusions
Stem-cell-mioblasts therapy may represent in the future an every-day intervention in the urologist's armamentarium. At least for this group of patients, to whom, from the pathogenic point of view, the deficiency is limited to the urethral sphincter, part of the excretory system, we believe that the urologist's interest should be maximal. The effectiveness of this treatment can change the course of therapy and last but not least, the accessibility to urological evaluation of patients with stress urinary incontinence.
The Centers of Excellence in Urology must develop research programs and become partners in multicenter studies in order to obtain solid long term data. Thus, new standards will be created that will be approved by urologists everywhere.